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World Journal of Surgical Oncology
Published in: World Journal of Surgical Oncology 1/2012

Open Access 01-12-2012 | Research

The clinicopathological features of colorectal mucinous adenocarcinoma and a therapeutic strategy for the disease

Authors: Masakatsu Numata, Manabu Shiozawa, Takuo Watanabe, Hiroshi Tamagawa, Naoto Yamamoto, Soichiro Morinaga, Kazuteru Watanabe, Teni Godai, Takashi Oshima, Shoichi Fujii, Chikara Kunisaki, Yasushi Rino, Munetaka Masuda, Makoto Akaike

Published in: World Journal of Surgical Oncology | Issue 1/2012

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Abstract

Background

The guidelines established by the National Comprehensive Cancer Network do not describe mucinous histology as a clinical factor that should influence the therapeutic algorithm. However, previous studies show conflicting results regarding the prognosis of colorectal mucinous adenocarcinoma. In this study, we described the clinicopathological features of mucinous adenocarcinoma in Japan, to identify optimal therapeutic strategies.

Methods

144 patients with mucinous and 2673 with non-mucinous adenocarcinomas who underwent primary resection in two major centers in Yokohama, Japan were retrospectively evaluated for clinicopathological features and treatment factors. A multivariate analysis for overall survival followed by the comparison of overall survival using Cox proportional hazard model were performed.

Results

Patients with mucinous adenocarcinoma had larger primary lesions, higher preoperative CEA levels, a deeper depth of invasion, higher rates of nodal and distant metastasis, and more metastatic sites. A multivariate analysis for overall survival revealed a mucinous histology to be an independent prognostic factor. In the subgroup analysis stratified by stage, Patients diagnosed as StageIII and IV disease had a worse survival in mucinous adenocarcinoma than non-mucinous, while survival did not differ significantly in patients diagnosed as Stage0-II disease. In StageIII, local recurrence in rectal cases and peritoneal dissemination were more frequently observed in patients with a mucinous histology.

Conclusions

Our study indentified that mucinous adenocarcinoma was associated with a worse survival compared with non-mucinous in patients with StageIII and IV disease. In rectal StageIII disease with mucinous histology, additional therapy to control local recurrence followed by surgical resection may be a strategical alternative. Further molecular investigations considering genetic features of mucinous histology will lead to drug development and better management of peritoneal metastasis
Appendix
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Literature
1.
Weitz J, Koch M, Debus J, Hohler T, Galle PR, Buchler MW: Colorectal cancer. Lancet. 2005, 365: 153-165. 10.1016/S0140-6736(05)17706-X.CrossRefPubMed
2.
Hamilton SR, Aaltonen LA: Pathology and Genetics, Tumours of the Digestive System. In World Health Organization Classification of Tumours. 2000, IARC, Lyon, 3
3.
Chew MH, Yeo SA, Ng ZP, Lim KH, Koh PK, Ng KH, Eu KW: Critical analysis of mucin and signet ring cell as prognostic factors in an Asian population of 2,764 sporadic colorectal cancers. Int J Colorectal Dis. 2010, 25: 1221-1229. 10.1007/s00384-010-1033-3.CrossRefPubMed
4.
Thomas RM, Sobin LH: Gastrointestinal cancer. Cancer. 1995, 75: 154-170. 10.1002/1097-0142(19950101)75:1+<154::AID-CNCR2820751305>3.0.CO;2-Z.CrossRefPubMed
5.
Green JB, Timmcke AE, Mitchell WT, Hicks TC, Gathright JB, Ray JE: Mucinous carcinoma–just another colon cancer?. Dis Colon Rectum. 1993, 36: 49-54. 10.1007/BF02050301.CrossRefPubMed
6.
Safaee A, Moghimi-Dehkordi B, Fatemi SR, Ghiasi S, Nemati-Malek F, Zali MR: Characteristics of colorectal mucinous adenocarcinoma in Iran. Asian Pac J Cancer Prev. 2010, 11: 1373-1375.PubMed
7.
Symonds DA, Vickery AL: Mucinous carcinoma of the colon and rectum. Cancer. 1976, 37: 1891-1900. 10.1002/1097-0142(197604)37:4<1891::AID-CNCR2820370439>3.0.CO;2-Z.CrossRefPubMed
8.
Xie L, Villeneuve PJ, Shaw A: Survival of patients diagnosed with either colorectal mucinous or non-mucinous adenocarcinoma: a population-based study in Canada. Int J Oncol. 2009, 34: 1109-1115.CrossRefPubMed
9.
10.
Zhang H, Evertsson S, Sun X: Clinicopathological and genetic characteristics of mucinous carcinomas in the colorectum. Int J Oncol. 1999, 14: 1057-1061.PubMed
11.
Kim DH, Kim JW, Cho JH, Baek SH, Kakar S, Kim GE, Sleisenger MH, Kim YS: Expression of mucin core proteins, trefoil factors, APC and p21 in subsets of colorectal polyps and cancers suggests a distinct pathway of pathogenesis of mucinous carcinoma of the colorectum. Int J Oncol. 2005, 27: 957-964.PubMed
12.
Song GA, Deng G, Bell I, Kakar S, Sleisenger MH, Kim YS: Mucinous carcinomas of the colorectum have distinct molecular genetic characteristics. Int J Oncol. 2005, 26: 745-750.PubMed
13.
Purdie CA, Piris J: Histopathological grade, mucinous differentiation and DNA ploidy in relation to prognosis in colorectal carcinoma. Histopathology. 2000, 36: 121-126. 10.1111/j.1365-2559.2000.00826.x.CrossRefPubMed
14.
Compton C, Fenoglio-Preiser CM, Pettigrew N, Fielding LP: American Joint Committee on Cancer Prognostic Factors Consensus Conference: Colorectal Working Group. Cancer. 2000, 88: 1739-1757. 10.1002/(SICI)1097-0142(20000401)88:7<1739::AID-CNCR30>3.0.CO;2-T.CrossRefPubMed
15.
Engstrom PF, Arnoletti JP, Benson AB, Chen YJ, Choti MA, Cooper HS, Covey A, Dilawari RA, Early DS, Enzinger PC, Fakih MG, Fleshman J, Fuchs C, Grem JL, Kiel K, Knol JA, Leong LA, Lin E, Mulcahy MF, Rao S, Ryan DP, Saltz L, Shibata D, Skibber JM, Sofocleous C, Thomas J, Venook AP, Willett C: National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: colon cancer. J Natl Compr Canc Netw. 2009, 7: 778-831.PubMed
16.
Engstrom PF, Arnoletti JP, Benson AB, Chen YJ, Choti MA, Cooper HS, Covey A, Dilawari RA, Early DS, Enzinger PC, Fakih MG, Fleshman J, Fuchs C, Grem JL, Kiel K, Knol JA, Leong LA, Lin E, Mulcahy MF, Rao S, Ryan DP, Saltz L, Shibata D, Skibber JM, Sofocleous C, Thomas J, Venook AP, Willett C: National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: rectal cancer. J Natl Compr Canc Netw. 2009, 7: 838-881.PubMed
17.
Nozoe T, Anai H, Nasu S, Sugimachi K: Clinicopathological characteristics of mucinous carcinoma of the colon and rectum. J Surg Oncol. 2000, 75: 103-107. 10.1002/1096-9098(200010)75:2<103::AID-JSO6>3.0.CO;2-C.CrossRefPubMed
18.
Du W, Mah JT, Lee J, Sankila R, Sankaranarayanan R, Chia KS: Incidence and survival of mucinous adenocarcinoma of the colorectum: a population-based study from an Asian country. Dis Colon Rectum. 2004, 47: 78-85. 10.1007/s10350-003-0014-9.CrossRefPubMed
19.
Maksimovic S: Survival rates of patients with mucinous adenocarcinoma of the colorectum. Med Arh. 2007, 61: 26-29.PubMed
20.
Secco GB, Fardelli R, Campora E, Lapertosa G, Gentile R, Zoli S, Prior C: Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum. Oncology. 1994, 51: 30-34. 10.1159/000227306.CrossRefPubMed
21.
Consorti F, Lorenzotti A, Midiri G, Di Paola M: Prognostic significance of mucinous carcinoma of colon and rectum: a prospective case-control study. J Surg Oncol. 2000, 73: 70-74. 10.1002/(SICI)1096-9098(200002)73:2<70::AID-JSO3>3.0.CO;2-J.CrossRefPubMed
22.
Kanemitsu Y, Kato T, Hirai T, Yasui K, Morimoto T, Shimizu Y, Kodera Y, Yamamura Y: Survival after curative resection for mucinous adenocarcinoma of the colorectum. Dis Colon Rectum. 2003, 46: 160-167. 10.1007/s10350-004-6518-0.CrossRefPubMed
23.
Papadopoulos VN, Michalopoulos A, Netta S, Basdanis G, Paramythiotis D, Zatagias A, Berovalis P, Harlaftis N: Prognostic significance of mucinous component in colorectal carcinoma. Tech Coloproctol. 2004, 8 (Suppl 1): 123-125.CrossRef
24.
Edge SB, Byrd DR, Compton CC, Fritz A: AJCC Cancer Staging Manual 7th edn. 2010, AJCC, New York
25.
26.
Galandiuk S, Wieand HS, Moertel CG, Cha SS, Fitzgibbons RJ, Pemberton JH, Wolff BG: Patterns of recurrence after curative resection of carcinoma of the colon and rectum. Surg Gynecol Obstet. 1992, 174: 27-32.PubMed
27.
Compton CC, Fielding LP, Burgart LJ, Conley B, Cooper HS, Hamilton SR, Hammond ME, Henson DE, Hutter RV, Nagle R, Nielsen ML, Sargent DJ, Taylor CR, Welton M, Willett C: Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med. 2000, 124: 979-994.PubMed
28.
Winder T, Lenz HJ: Mucinous adenocarcinomas with intra-abdominal dissemination: a review of current therapy. Oncologist. 2010, 15: 836-844. 10.1634/theoncologist.2010-0052.PubMedCentralCrossRefPubMed
29.
Levin KE, Dozois RR: Epidemiology of large bowel cancer. World J Surg. 1991, 15: 562-567. 10.1007/BF01789199.CrossRefPubMed
30.
Wu CS, Tung SY, Chen PC, Kuo YC: Clinicopathological study of colorectal mucinous carcinoma in Taiwan: a multivariate analysis. J Gastroenterol Hepatol. 1996, 11: 77-81. 10.1111/j.1440-1746.1996.tb00014.x.CrossRefPubMed
31.
Umpleby HC, Ranson DL, Williamson RC: Peculiarities of mucinous colorectal carcinoma. Br J Surg. 1985, 72: 715-718. 10.1002/bjs.1800720915.CrossRefPubMed
32.
Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S, Shirouzu K, Muto T: Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum. 2006, 49: 1663-1672. 10.1007/s10350-006-0714-z.CrossRefPubMed
33.
Wong RK, Berry S, Spithoff K, Simunovic M, Chan K, Agboola O, Dingle B: Preoperative or postoperative therapy for stage II or III rectal cancer: an updated practice guideline. Clin Oncol (R Coll Radiol). 2010, 22: 265-271. 10.1016/j.clon.2010.03.002.CrossRef
34.
Min BS, Kim NK, Ko YT, Lee KY, Baek SH, Cho CH, Sohn SK: Long-term oncologic results of patients with distal rectal cancer treated by local excision with or without adjuvant treatment. Int J Colorectal Dis. 2007, 22: 1325-1330. 10.1007/s00384-007-0339-2.CrossRefPubMed
35.
Kurt M, Ozkan L, Yilmazlar T, Ercan I, Zorluoglu A, Memik F, Engin K: Postoperative concomitant chemoradiotherapy in locally advanced rectal cancer. Hepatogastroenterology. 2005, 52: 1411-1415.PubMed
36.
Minsky BD: Adjuvant therapy for rectal cancer–the transatlantic view. Colorectal Dis. 2003, 5: 416-422. 10.1046/j.1463-1318.2003.00504.x.CrossRefPubMed
37.
Sadeghi B, Arvieux C, Glehen O, Beaujard AC, Rivoire M, Baulieux J, Fontaumard E, Brachet A, Caillot JL, Faure JL, Poercheron J, Peix JL, François Y, Vignal J, Gilly FN: Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer. 2000, 88: 358-363. 10.1002/(SICI)1097-0142(20000115)88:2<358::AID-CNCR16>3.0.CO;2-O.CrossRefPubMed
38.
Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H, Zoetmulder FA: Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003, 21: 3737-3743. 10.1200/JCO.2003.04.187.CrossRefPubMed
39.
Negri FV, Wotherspoon A, Cunningham D, Norman AR, Chong G, Ross PJ: Mucinous histology predicts for reduced fluorouracil responsiveness and survival in advanced colorectal cancer. Ann Oncol. 2005, 16: 1305-1310. 10.1093/annonc/mdi244.CrossRefPubMed
40.
Catalano V, Loupakis F, Graziano F, Torresi U, Bisonni R, Mari D, Fornaro L, Baldelli AM, Giordani P, Rossi D, Alessandroni P, Giustini L, Silva RR, Falcone A, D’Emidio S, Fedeli SL: Mucinous histology predicts for poor response rate and overall survival of patients with colorectal cancer and treated with first-line oxaliplatin- and/or irinotecan-based chemotherapy. Br J Cancer. 2009, 100: 881-887. 10.1038/sj.bjc.6604955.PubMedCentralCrossRefPubMed
41.
Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, Nakamura Y, White R, Smits AM, Bos JL: Genetic alterations during colorectal-tumor development. N Engl J Med. 1988, 319: 525-532. 10.1056/NEJM198809013190901.CrossRefPubMed
42.
Leopoldo S, Lorena B, Cinzia A, Gabriella DC, Angela Luciana B, Renato C, Antonio M, Carlo S, Cristina P, Stefano C, Maurizio T, Luigi R, Cesare B: Two subtypes of mucinous adenocarcinoma of the colorectum: clinicopathological and genetic features. Ann Surg Oncol. 2008, 15: 1429-1439. 10.1245/s10434-007-9757-1.CrossRefPubMed
Metadata
Title
The clinicopathological features of colorectal mucinous adenocarcinoma and a therapeutic strategy for the disease
Authors
Masakatsu Numata
Manabu Shiozawa
Takuo Watanabe
Hiroshi Tamagawa
Naoto Yamamoto
Soichiro Morinaga
Kazuteru Watanabe
Teni Godai
Takashi Oshima
Shoichi Fujii
Chikara Kunisaki
Yasushi Rino
Munetaka Masuda
Makoto Akaike
Publication date
01-12-2012
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2012
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/1477-7819-10-109

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